This month JC will be looking at the management of acute CO poisoning. Every year we get an increase in referrals to the hyperbaric oxygen (HBO) therapy center at our local HBO facility for CO poisoning. In particular, the winter months bring referrals because of an increase in the use of space heaters, fireplaces and sadly, depression. During the hurricane season, we get referrals from those who think placing generators in garages, unused bedrooms or outside open windows is a good idea. For many, the management of these patients remains ambiguous and guidelines including our own ACEP Guidelines provide lukewarm guidance. RCT’s and blinded, unbiased HBO trials are difficult to design and consequently excellent data is lacking. So how do we best manage the acute CO poisoning?  We will take a look at the most highly cited articles and attempt to define a reasonable approach in our management of these challenging cases. 

Delayed neuropsychologic sequelae after carbon monoxide poisoning: Prevention by treatment with hyperbaric oxygen, Ann Emerg Med 1995; 25: 474-480.

Hyperbaric oxygen for acute carbon monoxide poisoning, NEJM 2002; 347: 1057-1067.  

Hyperbaric oxygen therapy for acute domestic carbon monoxide poisoning: two randomized controlled trials, Intensive Care Med 2011

Clinical policy: Critical issues in the management of adult patients presenting to the emergency department with acute carbon monoxide poisoningAmerican College of Emergency Physicians. Ann Emerg Med. 2008 Feb;51(2):138-52